Application Form

Application Form

Application Deadline - April 17 of award year
You must submit your materials through this on-line application system. If you have any questions, please ask your center representative.

A God Send’s website offers additional information about this scholarship. The application, nomination, and letter of recommendation forms are also done via the website.

I have read and understand the conditions of the MMLCL Scholarship. I affirm that I plan to pursue a life that is positive and free from legal violations. I commit to education, training and work outlets that will strengthen my life and allow me to be able to positively impact my community and the lives of others.

If selected as a MMLCL Scholar, I agree to attend the MMLCL Scholar Awards Ceremony.

All winners will be notified on or before the October 1 of the award year.
I give permission to officials of my center to release transcripts of my academic record, performance appraisals and any other information requested for consideration in the MMLCL Scholarship program. I understand this application will be available only to qualified people who need to see it in the course of their duties. I waive the right to access letters of recommendation written on my behalf. *

Yes, I do
I affirm that all of this application is my own work or formally cited from other sources. I affirm the information contained herein is true and accurate to the best of my knowledge and belief. *

Yes, I do
Read and Understand the instructions. *

Yes, I have
If selected, you will be asked for documentation to support the data you provide. Likewise, all correspondence and award agreements will be generated from the personal information submitted below. So, please use proper spelling, capitalization and punctuation.
I. Personal Data:

Tell us about yourself
Full Legal Name *

First Name Middle Name (if none put N/A) Last Name
Birthdate: *

Month Day Year
Mobile No. : *

Area Code Phone Number
E-mail : *
Where the confirmation will be send to

Current Residence Address : *

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Permanent Residence Address : *

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

How is permanent residence established?

Home Address Voters registration Family's primary residence Other
Optional Informations :

Information regarding gender, ethnic origin and race are optional. The information is requested for post-scholarship report generation only and in no way affects your selection for college scholarship awards. However, providing this information may increase your opportunities for scholarships where donors have asked that priority consideration be given to students meeting certain demographic criteria (such as minority status, parent's place of employment, area of study, etc.)
Gender:

Male Female
Are you a US citizen?

Yes No
Ethnic Origin:

Hispanic Non-Hispanic Not Indicated
Race? (Choose one or more):

White Black or African American Asian American Indian or Alaskan Native Hawaiian or Other Pacific Islander Non-Resident Alien
Please check veteran status (Check all that apply)

Veteran Child of a Veteran Grandchild of a Veteran Spouse of a Veteran None of the Above
Were you born outside the USA?

Yes No
Were your parents born outside the USA?

Yes No
If so, what country?
Do you have a disability?

Yes No
Are you a member of any religious organization?

Yes No
If so, which one?
Status at the time of application:

I will graduate a minimum of 6 months before October 17 I have attended college but have less than 32 college credit hours I have attended college but have at least 32 or more college credit hours I am a GED graduate with no college credit hours
Do you plan to attend college ?

Yes, but I have not began looking . Yes, and I have started looking. No
What is your Career Objective:

0/300
II. High School Information:
Are you or will you be a high school graduate?

Yes No
High School Attended:
Year of High School Graduation or GED:
III. For Students Currently Enrolled in college :
Name of school you are attending:
Approximate credit hours completed:
Current GPA:
School activities, honors, offices held, etc.:
Have you ever received a scholarship?

Yes No
IV. Academic and Personal Achievements:

All answers are required. Please put N/A if the question does not apply to you.
1a. List any college from which you have graduated : *

List school and date 0/300
1b. List any college you have attended but did not graduate from: *

List school and date 0/300
2a. List any high school activities (student government, sports, publications, school-sponsored community service programs, student-faculty committees, arts, music, etc.). you participated in. List the most important first. : *

List activity or office and date 0/300
2b. List college activities (student government, sports, publications, school-sponsored community service programs, student-faculty committees, arts, music, etc.) you participated in. List the most important first. *

List activity or office and date 0/300
3. List public service and community activities (homeless services, advocacy activities, work with religious organizations, etc.). Do not repeat items listed previously. List the most important one first. : *

List activity, role, dates and number of weeks you participated 0/300
4. List government activities (internships with government agencies, partisan political activities, ROTC/military). List student government under Item 2.: *

List activity, role, dates and number of weeks you participated 0/300
5. List part-time and full-time jobs and non-government internships (for past 2 years).: *

List type of work, employer, dates and average hours/week worked 0/300
6. List awards, scholarships, publications or special recognition you have received. List the most important one first. : *

0/300
7. Describe one specific example of you demonstrating your commitment to your success and plan to keep moving forward. (The writer of your letter of recommendation must confirm this experience.): *

0/300
8. Describe a recent particularly satisfying public service activity (do not repeat experience described in 7). (The writer of your letter of recommendation must confirm this experience.): *

0/300
9. Describe a problem or need of our society you would change if you got the opportunity to.: *

0/300
10. Name at least three significant people in your life and tell why they are significant.: *

0/300
11. Describe the plan you have for leadership and/or continued academic success. (The writer of your letter of recommendation must confirm this plan.) : *

0/300
12. What do you hope to do and what job or career path do you hope to have within a year?: *

0/300
13. What do you hope to do and what position do you hope to have five years from now? : *

0/300
Do you have a relationship with anyone affiliated with A God Send, Inc.?

Yes No
If yes, Name and type of affiliation/relationship:
VII. Essay
Your essay should be 300-500 words. You should address in your essay: your goals, anything that has not been metioned in this application previously, and why this scholarship is important to you.

Take this time to share any personal information: academic and non-academic accomplishments, personal characteristics, or experiences, you believe the scholarship baord needs to know, that would make you uniquely worthy of scholarship consideration.
Essay:

0/500
VIII. Applicant's E-Signature
By signing (typing your legal name) in the space below, you are certifying that all information is correct and that you are the person completing this application. When you press the submit button, you will receive an email confirmation that your application was received. Please print for your records and retain as verification of your application.
E-Signature: *
A God Send, Inc. is committed to equal opportunity in the assigning this scholarship and in all business dealing. We do not discriminate in any program or activity on the basis of race, color, religion, gender, age, national origin, disability, marital status, or any other protected class.

The image for this scholarship form was provided by Steelcase at www.steelcase.com
Should be Empty:

I. Personal Data:

II. High School Information:

III. For Students Currently Enrolled in college :

IV. Academic and Personal Achievements:

VII. Essay

VIII. Applicant's E-Signature